Provider Demographics
NPI:1770355398
Name:PSYCHOLOGICAL EVALUATION CENTER OF NORTH AMERICA (PECNA)
Entity type:Organization
Organization Name:PSYCHOLOGICAL EVALUATION CENTER OF NORTH AMERICA (PECNA)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRADA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTANAVITUKUL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:949-949-0002
Mailing Address - Street 1:34821 CAMINO CAPISTRANO
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1722
Mailing Address - Country:US
Mailing Address - Phone:949-949-0002
Mailing Address - Fax:
Practice Address - Street 1:1003 BISHOP STREET
Practice Address - Street 2:SUITE 2700 PMB #368
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-9262
Practice Address - Country:US
Practice Address - Phone:949-949-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty